3 The general background in the North of Sweden: Long distances. Expensive transports Artic circle Limited access to cardiac experts More elderly people will need health care, nursing and rehabilitation. Distance 1000 miles New kinds of hospitals, smaller but more specialized towards acute treatment.

4 Demografi - More elderly more need of care Society - Less hospitals - Increased health care charges - Limited economy - Rural areas - Fair and equal healthcare - More people want to live at their homes - More treatment and rehabilitation of patients at their homes.

5 The CHF background in Sweden: : CHF is the only cardiovascular condition in which both the prevalence and the incidence continue to rise. 1 CHF is the leading cause of hospitalisation amongst the >65 year age group 3 Annual inpatient and outpatient expenditure on CHF in Sweden has been estimated at SEK 2.6 billion 2 1Yamani & Massie (1993); 2Rydén-Bergsten et al (1999); 3Graves & Bilium (1996);

14 Medirob A Mobile remote controlled robotic arm that holds the transducer during the ultrasound examination of a patient. (Mobile Robotics AB)

15

16

17 P r i m a r y H e a l t h C a r e

18 Trackball Echo-examination

19

20 Following consultation

21 CARDISTA - advantages The patient feels safety with his ordinary GP and PHC. At the consultation both patient and GP share the same information

22 Advantages with consultation by Right diagnose Right treatment Right treatment level telemedicine - If the patients can be managed by the GP or if they need a specialist? Communication Large value of education Short time of consultation for the specialist

26 CARDISTA-study Aim: To see if CARDISTA can reduce the waiting time towards traditionell care until the patient get the results. Inclusion criteria: All patients that the general practitioner thought needed echo with cardiological The manuscript evaluation. work is started Exclusion criteria: Patients that refused to participate. 40 patients randomised to traditionell echo examination at hospital or CARDISTA

30 Telemedicin makes monitoring of anticoagulantia more effective The GINA-study

31 Background - advantages Treatment with Warfarin is very common and effective as tromboembolic prophylaxis. Treatment with Warfarin saves many lives and suffering. International Normalization Ratio (INR)-controlls in patients with warfarin in Sweden are of high class internationally

32 Background - disadvantages Treatment with Warfarin is also potentially dangerous and may cause deaths and severe bleeding complications. INR-controlls are currently timeconsuming but extremely important

37 Intervention: INR monitoring process performed with either CheckUp or UC. Patients: Forty patients on chronic warfarin therapy (20 per PHC, ten monitored using CheckUp and ten monitored and with the UC) results. each received three INR measurements. Main Outcome Measures: Total processing time was measured from blood sampling until warfarin dosing was performed in the Auricula database.

40 Conclusion CheckUp reduced the total processing time for INR monitoring, mainly through the rapid transmission of INR value from each PHC to Auricula. CheckUp may improve the practical management of patients undergoing anticoagulant treatment at PHCs. Published online in Journal of Telemedicine and Telecare

41 The National Board of Health and Welfare recommends (2008) selftesting (prio 3) The patients comments were positive: Easier sampling, quick answer It is difficult with venous sampling on me, therefore I like blood test from my finger

Stiftelsen Allmänna Barnhuset KARLSTADS UNIVERSITET National Swedish parental studies using the same methodology have been performed in 1980, 2000, 2006 and 2011 (current study). In 1980 and 2000 the studies

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